Continuous monitoring of gastric intraluminal carbon dioxide pressure, cardiac output, and end-tidal carbon dioxide pressure in the perioperative period in patients receiving cardiovascular surgery using cardiopulmonary bypass

Imai, Takasuke; Sekiguchi, Tetsushi; Nagai, Yuko; Morimoto, Takushi; Nosaka, Takuto; Mitaka, Chieko; Makita, K.; Sunamori, Makoto

doi:10.1097/00003246-200201000-00007

Cited by 8 publications

(4 citation statements)

References 50 publications

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“…However, differences in transurgical PCO 2 gap values had no predictive value of postoperative outcome. In agreement with the data reported by Imai et al (2002), the PCO 2 gap changes during the first ICU hour correlated with postoperative morbidity although in the present study the differences did not reach statistical significance. In addition, gastric impedance parameters showed higher sensitivity than other global pressure-related variables used in clinical practice.…”

Section: Discussionsupporting

confidence: 91%

“…Several new technologies are currently under development; however, to date no useful method to directly monitor the level of end organ tissue injury is available in clinical practice. Gastric tonometry (Bohrer et al 1997, Bennett-Guerrero et al 2000, Janssens et al 2000, Perez et al 2000, Imai et al 2002, regional capnometry (Lebuffe et al 1999), esophageal doppler ultrasonography (Poeze et al 1999), and more recently, near infrared spectroscopy (NIRS) (Uilkema and Groeneveld 2007) have been used to monitor end-organ perfusion in cardiac surgery patients. Nevertheless, these monitoring techniques do not give an estimate of the level of tissue compromise after prolonged ischemia.…”

Section: Introductionmentioning

confidence: 99%

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The predictive value of gastric reactance for postoperative morbidity and mortality in cardiac surgery patients

Beltran¹,

Sánchez-Miranda

Godinez³

et al. 2010

Physiol. Meas.

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No useful method to directly monitor the level of end organ tissue injury is currently available clinically. Gastric reactance has been proposed to measure changes in a tissue structure caused by ischemia. The purpose of this study was to assess whether gastric reactance is a reliable, clinically relevant predictor of complications and a potentially useful tool to assess hypoperfusion in cardiovascular surgery patients. The value of gastric reactance measurements, standard hemodynamic and regional perfusion variables, and scores to predict postoperative complications were compared in 55 higher risk cardiovascular surgery patients with cardiopulmonary bypass. Low frequency gastric reactance, X(L), had a significant predictive value of postoperative persistent shock requiring more than 48 h of vasopressors and associated complications, before, during and after surgery (p < 0.05). Results suggest that reactance is an earlier predictor of patients at risk than all other variables tested. Patients with a high reactance (X(L) > 26) before surgery had a significantly higher incidence of complications, higher mortality and more days in the ICU than patients with a low reactance (X(L) < 13). X(L) was found to be a reliable and clinically relevant measurement. These results justify further clinical research to explore how this information may be used to improve patient management.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

The predictive value of gastric reactance for postoperative morbidity and mortality in cardiac surgery patients

Beltran¹,

Sánchez-Miranda

Godinez³

et al. 2010

Physiol. Meas.

View full text Add to dashboard Cite

show abstract

“…Conjunctival carbon dioxide tension did change significantly during testing. One study of gastric luminal PCO 2 during CPB demonstrated declining values initially, and, similar to our findings, an increase upon the restoration of pulsatile flow (18). These authors attributed this finding to the increasing acidosis in tissues that are not perfused.…”

Section: Discussionsupporting

confidence: 89%

“…A prior investigation which measured muscle gastric mucosal oxygen levels during JECT. 2011;43: [13][14][15][16][17][18] CPB showed that tissue oxygenation fell sharply during the initiation of cardiopulmonary bypass and remained significantly below baseline for 3 to 5 hours following the procedure (19). These investigators did not find any relationship between arterial blood gas levels and the tissue pH or oxygen tension.…”

Section: Discussionmentioning

confidence: 98%

Monitoring the Conjunctiva for Carbon Dioxide and Oxygen Tensions and pH During Cardiopulmonary Bypass

Weiss¹,

Isenberg²,

McArthur³

et al. 2011

J Extra Corpor Technol

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The purpose of this study was to measure, for the first time, multiple physiologic parameters of perfusion (pH, PCO2, PO2, and temperature) from the conjunctiva of adult patients during cardiopulmonary bypass while undergoing cardiothoracic surgery. Ten patients who underwent either intracardiac valve repair, atrial septal defect repair, or coronary artery bypass graft surgery had placement of a sensor which directly measured pH, PCO2, PO2, and temperature from the conjunctiva. Data were stratified into seven phases (0–5 minutes prior to bypass; 0–5, 6–10, and 11–15 minutes after initiation of bypass; 0–5 minutes prior to conclusion of bypass; and 0–5 and 6–10 minutes after bypass) and analyzed using a mixed model analysis. The change in conjunctival pH over the course of measurement was not statistically significant (p = .56). The PCO2 level followed a quadratic pattern, decreasing from a mean pre-bypass level of 37.7 mmHg at baseline prior to the initiation of cardiopulmonary bypass to a nadir of 33.2 mmHg, then increasing to a high of 39.4 mmHg at 6–10 minutes post bypass (p < .01). The PO2 declined from a mean pre-bypass level of 79.5 mmHg to 31.3 mmHg by 6–10 minutes post bypass and even post-bypass, it never returned to baseline values (p < .01). Temperature followed a pattern similar to PCO2 by returning to baseline levels as the patient was re-warmed following bypass (p < .01). There was no evidence of any eye injury or inflammation following the removal of the sensor. In the subjects studied, the conjunctival sensor yielded reproducible measurements during the various phases of cardiopulmonary bypass without ocular injury. Further study is necessary to determine the role of conjunctival measurements in critical settings.

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Monitoring Anesthetized Patients

Haskins

2015

Veterinary Anesthesia and Analgesia

122

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Continuous monitoring of gastric intraluminal carbon dioxide pressure, cardiac output, and end-tidal carbon dioxide pressure in the perioperative period in patients receiving cardiovascular surgery using cardiopulmonary bypass

Cited by 8 publications

References 50 publications

The predictive value of gastric reactance for postoperative morbidity and mortality in cardiac surgery patients

The predictive value of gastric reactance for postoperative morbidity and mortality in cardiac surgery patients

Monitoring the Conjunctiva for Carbon Dioxide and Oxygen Tensions and pH During Cardiopulmonary Bypass

Monitoring Anesthetized Patients

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